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Pronunciation |
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(dye
mer KAP
role) |
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U.S. Brand
Names |
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BAL in
Oil® |
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Generic
Available |
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No |
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Synonyms |
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BAL; British Anti-Lewisite; Dithioglycerol |
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Pharmacological Index |
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Antidote |
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Use |
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Antidote to gold, arsenic (except arsine), and mercury poisoning (except
nonalkyl mercury); adjunct to edetate calcium disodium in lead poisoning;
possibly effective for antimony, bismuth, chromium, copper, nickel, tungsten, or
zinc |
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Pregnancy Risk
Factor |
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C |
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Contraindications |
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Hepatic insufficiency (unless due to arsenic poisoning); do not use on iron,
cadmium, or selenium poisoning |
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Warnings/Precautions |
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Potentially a nephrotoxic drug, use with caution in patients with oliguria or
glucose 6-phosphate dehydrogenase deficiency; keep urine alkaline to protect
kidneys; administer all injections deep I.M. at different
sites |
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Adverse
Reactions |
|
>10%:
Cardiovascular: Hypertension, tachycardia (dose-related)
Central nervous system: Headache
1% to 10%: Gastrointestinal: Nausea, vomiting
<1%: Nervousness, fever, convulsions, salivation, transient neutropenia,
thrombocytopenia, increased PT, pain at the injection site, abscess formation,
myalgia, paresthesia, blepharospasm, burning eyes, nephrotoxicity, dysuria,
burning sensation of the lips, mouth, throat, and penis |
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Drug
Interactions |
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Toxic complexes with iron, cadmium, selenium, or uranium |
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Stability |
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Do not mix in the same syringe with edetate calcium
disodium |
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Mechanism of
Action |
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Sulfhydryl group combines with ions of various heavy metals to form
relatively stable, nontoxic, soluble chelates which are excreted in
urine |
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|
Pharmacodynamics/Kinetics |
|
Distribution: Distributes to all tissues including the brain
Metabolism: Rapidly to inactive products
Time to peak serum concentration: 0.5-1 hour
Elimination: In urine |
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Usual Dosage |
|
Children and Adults: Deep I.M.:
Lead poisoning (in conjunction with calcium EDTA): For symptomatic acute
encephalopathy or blood level >100 mcg/dL: 4-5 mg/kg every 4 hours for 3-5
days |
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Administration |
|
Administer deep I.M. only |
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Test
Interactions |
|
Iodine 131I thyroidal uptake values may be
decreased |
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Mental Health: Effects
on Mental Status |
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May cause nervousness |
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Mental Health:
Effects on Psychiatric
Treatment |
|
May produce neutropenia; use caution with clozapine and
carbamazepine |
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|
Dental Health: Local
Anesthetic/Vasoconstrictor
Precautions |
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No information available to require special precautions |
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Dental Health:
Effects on Dental Treatment |
|
No effects or complications reported |
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|
Patient
Information |
|
Frequent blood and urine tests may be required |
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Nursing
Implications |
|
Urine should be kept alkaline because chelate dissociates in acid
media |
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Dosage Forms |
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Injection: 100 mg/mL (3 mL) |
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|
References |
|
Cantilena LR Jr and Klaassen CD,
"The Effect of Chelating Agents on the Excretion of Endogenous Metals,"
Toxicol Appl Pharmacol, 1982, 63(3):344-50.
Kosnett MJ, "Unanswered Questions in Metal Chelation," J Toxicol Clin
Toxicol, 1992, 30(4):529-47.
"Treatment Guidelines for Lead Exposure in Children. American Academy of Pediatrics Committee on Drugs,"
Pediatrics, 1995, 96(1 Pt 1):155-60.
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